Ala. Admin. Code r. 560-X-47-.02

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-47-.02 - Eligibility

(1) Financial eligibility is limited to individuals eligible for Medicaid under the Alabama State Plan.

(2) Treatment eligibility is limited to individuals with a diagnosis, assigned by a licensed physician, a licensed psychologist, a licensed physician's assistant, a certified registered nurse practitioner, a licensed professional counselor or associate licensed counselor of mental illness or substance abuse as listed in the most current International Classification of Diseases - Clinical Modification (ICD-CM). The Z codes are not covered for adult rehabilitative treatment services; however, the intake evaluation and diagnostic assessment will be covered even if the resulting diagnosis is a Z code. For treatment services provided to children under 21 or adults receiving DHR protective services, the only Z code covered for reimbursement is Z65.9, problem related to unspecified psychosocial circumstances.

(3) Providers of rehabilitative services shall meet the following eligibility requirements:

(a) Shall be in full compliance with applicable federal and state laws and regulations including compliance with the requirements expressed in the current version of the Medicaid Provider Manual, Rehabilitative Services, Chapter 105;

(b) Shall submit evidence to Medicaid of full compliance with 560-X-47-.03; and have such compliance approved in advance; and

(c) Shall execute the Medicaid non-institutional provider agreement with appropriate attachments.

Ala. Admin. Code r. 560-X-47-.02

Rule effective August 11, 1990. Amended: effective August 14, 1991. Emergency rule effective March 1,1994. Amended: Filed May 6, 1994, effective June 14, 1994. Amended: Filed May 11, 2001; effective June 15, 2001. Amended: Filed May 12, 2005; effective June 16, 2005.

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 10, July 31, 2015, eff. 8/18/2015.

Amended by Alabama Administrative Monthly Volume XXXVII, Issue No. 04, January 31, 2019, eff. 2/25/2019.

Author: Karen M. Smith, Associate Director, Mental Health Programs

Statutory Authority:42 C.F.R. § 440.130(d); Social Security Act, Title XIX; Omnibus Budget Reconciliation Act of 1987, P.L. 100-203, §4105; State Plan for Medical Assistance, Attachment 3.1-A.